Latent traits of impulsivity and compulsivity: toward dimensional psychiatry

Differential effects of sertraline and cognitive behavioural therapy on behavioural inhibition in patients with obsessive compulsive disorder

Patients with obsessive compulsive disorder (OCD) randomised to sertraline, manualised cognitive behavioural therapy (CBT), or combination (sertraline + CBT), underwent cognitive assessment. Cognitive testing was conducted at baseline and at week 16. The stop signal reaction time task (SSRT) was used to evaluate motor impulsivity and attentional flexibility was evaluated using the intra/extra-dimensional set shifting task. Paired-samples t -tests or nonparametric variants were used to compare baseline and posttreatment scores within each treatment group. Forty-five patients were tested at baseline (sertraline n  = 14; CBT n  = 14; sertraline + CBT n  = 17) and 23 patients at week 16 (sertraline n  = 6; CBT n  = 7; sertraline + CBT n  = 10). The mean dosage of sertraline was numerically higher in those taking sertraline as a monotherapy (166.67 mg) compared with those taking sertraline in combination with CBT (100 mg). Analysis of pre-post treatment scores using an intent-to-treat-analysis found a significant reduction in the SSRT in those treated with sertraline, whilst there was no significant change on this task for those treated with CBT or the combination. This study found that motor inhibition improved significantly following sertraline monotherapy. Suboptimal sertraline dosing might explain the failure to detect an effect on motor inhibition in the group receiving combination of sertraline + CBT. Higher dose sertraline may have broader cognitive effects than CBT for OCD, motor impulsivity may have value as a measure of treatment outcome and, by extension, the SSRT could serve as a biomarker for personalising care.

In vivo calcium extrusion from accumbal astrocytes reduces anxiety-like behaviors but increases compulsive-like responses and compulsive ethanol drinking in mice

The ventral striatum is crucially involved in reward processing. The present study investigates the behavioral effects of astrocyte-specific calcium extrusion virus "CalEx" on perseverative responses in the operant five-choice serial reaction time task and ethanol-conditioned place preference. Mice were injected with CalEx via the GfaABC1D promoter to extrude cytosolic calcium from astrocytes within the ventral striatum. We found that CalEx transfection in the ventral striatum reduced evoked response duration, the maximum amplitude, and the response frequency to 500 μM ATP as measured by ΔF/F fluorescence intensity of the genetically encoded calcium indicator targeting astrocytes GCaMP6f. During the five-choice serial reaction time task, CalEx mice persisted in perseverative responses compared to their counterparts. Additionally, during ethanol-conditioned place preference, CalEx mice showed increased place preference for a low ethanol concentration compared to control group. Furthermore, we found that accumbal astrocytic calcium extrusion increased quinine adulterated ethanol drinking. Our findings suggest that diminishing ventral striatum astrocyte calcium activity contributes to compulsive behaviors, ethanol drinking, and enhanced ethanol drug reward.

Recent advances in understanding how compulsivity is related to behavioural addictions over their timecourse

Purpose of Review

Behavioural addictions involve loss of control over initially rewarding behaviours, which continue despite adverse consequences. Theoretical models suggest that these patterns of behaviour evolve over time, with compulsive and habitual behaviours held to reflect a loss of behavioural control. Compulsivity can be broadly described as a propensity for (or engagement in) repetitive behaviours that are not aligned with overall goals. Here, we consider whether compulsivity is associated with behavioural addictions at different stages of their development, based on self-report and neurocognitive measures.

Recent Findings

This review found that there is initial evidence that compulsive traits might predispose individuals to engage in problematic behaviours, and that self-report and neurocognitive measures of compulsivity are associated with severity of problematic behaviours even in the early stages of behavioural addictions. In the later stages of behavioural addiction, there is strong evidence for an association of gambling disorder with cognitive inflexibility, but less evidence for an association between compulsivity and other types of behavioural addiction.

Summary

Moving forwards, well-powered longitudinal studies, including studies using ecological momentary assessment (EMA), will be important in robustly developing our understanding of how compulsivity is related to behavioural addictions over their timecourse.

Proactive control for conflict resolution is intact in subclinical obsessive-compulsive individuals

Background

Obsessive-compulsive (OC) traits (i.e., tendency to implement stereotyped behaviors to avoid negative consequences) are transversally observed in psychiatric disorders largely differing in terms of clinical manifestations and etiopathogenesis. Interestingly, OC traits were also extensively found in the prodromal phases of the full-blown psychopathology and in healthy relatives of affected individuals. Moreover, OC traits were found to be associated—and possibly underlain by—cognitive control impairments. Nonetheless, the role of such interplay in the onset of OC disorders is yet to be understood. We hypothesized that OC traits are associated with abnormalities in proactively implement cognitive control for solving conflict.

Methods

We administered healthy individuals (n = 104) with the perifoveal spatial Stroop task to measure their ability of solving conflict in a proactive fashion, and with Obsessive-Compulsive Inventory (OCI) to stratify population according to the severity of OC traits.

Results

Analysis of response times by means of Linear Mixed-effect models revealed that proactive control performance was not associated with and the severity of OC traits. Furthermore, an equivalence test (Two One-Sided Test) revealed that the association between OCI scores and task performance was equivalent to zero.

Conclusion

These results suggest that the interplay between OC traits and proactive control abnormalities might not contribute to the development of OC-related disorders. Therefore, the role of other cognitive endophenotypes should be scrutinized for exploiting alternative prevention and intervention strategies.

A structural MRI marker predicts individual differences in impulsivity and classifies patients with behavioral-variant frontotemporal dementia from matched controls

Impulsivity and higher preference for sooner over later rewards (i.e., delay discounting) are transdiagnostic markers of many psychiatric and neurodegenerative disorders. Yet, their neurobiological basis is still debated. Here, we aimed at 1) identifying a structural MRI signature of delay discounting in healthy adults, and 2) validating it in patients with behavioral variant frontotemporal dementia (bvFTD)-a neurodegenerative disease characterized by high impulsivity. We used a machine-learning algorithm to predict individual differences in delay discounting rates based on whole-brain grey matter density maps in healthy male adults (Study 1, N=117). This resulted in a cross-validated prediction-outcome correlation of r=0.35 (p=0.0028). We tested the validity of this brain signature in an independent sample of 166 healthy adults (Study 2) and its clinical relevance in 24 bvFTD patients and 18 matched controls (Study 3). In Study 2, responses of the brain signature did not correlate significantly with discounting rates, but in both Studies 1 and 2, they correlated with psychometric measures of trait urgency-a measure of impulsivity. In Study 3, brain-based predictions correlated with discounting rates, separated bvFTD patients from controls with 81% accuracy, and were associated with the severity of disinhibition among patients. Our results suggest a new structural brain pattern-the Structural Impulsivity Signature (SIS)-which predicts individual differences in impulsivity from whole-brain structure, albeit with small-to-moderate effect sizes. It provides a new brain target that can be tested in future studies to assess its diagnostic value in bvFTD and other neurodegenerative and psychiatric conditions characterized by high impulsivity.

Causal attributions of impulsive and compulsive behaviors

Introduction

Aggression, and therefore gender-based violence, can be an impulsive or compulsive behavior, depending on the consumption of alcohol and/or drugs. In Europe, the prevalence of gender-based violence is 16 to 23%. This prevalence shows that there is a need to make further progress in the treatment of aggression against women. Qualitative techniques allow us to understand perceptions and attributions holistically by analyzing what people who commit the crime say, why they say it and how they say it.

Aim

To explore the experience of physical and verbal aggression by a partner, dependent on the presence or absence of alcohol and drug use, in the prison population.

Method

A mixed methodology was used (combining qualitative and quantitative techniques). The sample was made up of 140 men divided into two focus groups [with alcohol and/or drug consumption (SAD) and without alcohol and/or drug consumption (NSAD)] who completed the Demographic, Criminal and Behavioral Interview in Penitentiary Institutions; the Gender Violence Questionnaire (both developed for this study) and the MultiCAGE CAD-4 Questionnaire. Qualitative data were analyzed using thematic analysis and quantitative data were obtained using contingency tables.

Results

It was found that the SAD group attributed the crime committed to alcohol and/or drug consumption, while the NSAD group attributed it to jealousy and to their partner. The SAD group revealed that the consequence of the physical aggressions was to get what they were looking for from their partner and the consequences of the verbal aggressions was regret, unlike the NSAD group that did not get anything from the aggressions. The SAD group recognized that to avoid future aggressions they would have to avoid alcohol and/or drug use, while the NSAD group mentioned that they would have to avoid contact with their partner.

Discussion

The need to include perceptions and attributions as well as the use of alcohol and/or drugs is emphasized when assessing individuals who commit the crime of gender-based violence.

Disentangling associations between impulsivity, compulsivity, and performance monitoring

Disorders marked by high levels of impulsivity and compulsivity have been linked to changes in performance monitoring, specifically the error-related negativity (ERN). We investigated the relationship between performance monitoring and individual differences in impulsivity and compulsivity. A total of 142 participants were recruited into four groups, each with different combinations of impulsivity and compulsivity, and they performed a flanker task to assess error-related brain activity. We defined error-related brain activity as ERN amplitude and theta power. Single-trial regression was employed to analyze the amplitude differences between incorrect and correct trials within the ERN time window. The findings revealed that impulsivity, compulsivity, and different measures of response processing exhibited distinct interactions, which were influenced by the configuration of impulsivity and compulsivity, but also depended on the measure of response processing. Specifically, high compulsivity predicted larger ERN amplitudes in individuals with low impulsivity, whereas high impulsivity had no significant effect on ERN amplitude in individuals with low compulsivity. Furthermore, when both impulsivity and compulsivity were high, no significant increase in ERN amplitude was observed; instead, there was a reduced difference between incorrect and correct trials. No significant differences were found for theta power. While the association between error-related brain activity and transdiagnostic markers or psychopathology may be smaller than generally assumed, considering the interaction between different transdiagnostic markers and their facets can enhance our understanding of the complex associations that arise during the investigation of neural correlates of performance monitoring, specifically the ERN.

Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program

Introduction

Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited.

Methods

Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout.

Results

Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge.

Conclusion

Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.

The development and validation of the "SENSE" - Sensory and Behavioral Modulation Questionnaire for adults

Sensory modulation is critical for interacting with the physical and social environment. When sensory input from the environment is not properly perceived and modulated, it may elevate arausability, avoidant behavior, impair function and wellbeing. Sensory modulation difficulties (SMD) are mainly reported during childhood and are related to neurodevelopmental conditions such as Attention-Deficit Hyperactivity Disorder (ADHD). SMD in adulthood further deteriorate function and emotional status, hence should be screened and treated. Nonetheless, relevant measures of SMD for adults are limited. This study aims to establish the psychometric properties of the "SENSE" - Sensory and Behavioral Modulation Questionnaire for adults. Based on theoretical/clinical knowledge the SENSE measures sensitivity/arousability, habituation and avoidance. After establishing content and face validity, 663 participants aged 18-65 completed a sociodemographic and health questionnaire, the Adult ADHD Scale-5 (ASRS-5), the SENSE and the Highly Sensitive Person Scale (HSPS). Factor analysis approved the determination of SENSE scales. Medium- high internal consistency was found. SENSE discriminated between adults with/without ADHD and correlated with HSPS scores, confirming concurrent validity. CONCLUSIONS: SENSE has good psychometric properties and may be feasible for screening sensory-behavioral modulation difficulties in adults. Studies should further examine SENSE applicability to clinical populations.

Impulsive and compulsive reading comprehension in the prison population

BACKGROUND

Developmental dyslexia is characterized by reading and writing deficits that persist into adulthood. Dyslexia is strongly associated with academic underachievement, as well as impulsive, compulsive, and criminal behaviors. The aims of this study were to investigate impulsive or compulsive reading comprehension, analyzing the differences in reading errors between two distinct groups -one with Antisocial Personality Disorder (ASPD) and another with Obsessive-Compulsive Personality Disorder (OCPD) and examine their correlation with criminal behavior within a prison population.

METHODS

We gathered data from 194 participants: 81 with ASPD and 113 with OCPD from a prison center. Participants took part in interviews to gather data on demographic, criminal, and behavioral data. Additionally, the participants underwent various assessments, including the International Examination for Personality Disorders; Symptom Inventory, and Battery for the Assessment of Reading Processes in Secondary and High School - Revised.

RESULTS

Our analysis revealed differences in reading skills between the ASPD and OCPD groups. Specifically, the OCPD group showed poorer performance on lexical selection, semantic categorization, grammar structures, grammatical judgements, and expository comprehension when compared with the ASPD group. Conversely, the OCPD group obtained higher scores on narrative comprehension relative to the ASPD group.

CONCLUSIONS

The OCPD group showed slow lexical-phonological coding and phonological activation.

Impaired cognitive flexibility across psychiatric disorders

OBJECTIVE

Problems with cognitive flexibility have been associated with multiple psychiatric disorders, but there has been little understanding of how cognitive flexibility compares across these disorders. This study examined problems of cognitive flexibility in young adults across a range of psychiatric disorders using a validated computerized trans-diagnostic flexibility paradigm. We hypothesized that obsessive-compulsive spectrum disorders (eg, obsessive-compulsive disorder, trichotillomania, and skin-picking disorder) would be associated with pronounced flexibility problems as they are most often associated with irrational or purposeless repetitive behaviors.

METHODS

A total of 576 nontreatment seeking participants (aged 18-29 years) were enrolled from general community settings, provided demographic information, and underwent structured clinical assessments. Each participant undertook the intra-extra-dimensional task, a validated computerized test measuring set-shifting ability. The specific measures of interest were total errors on the task and performance on the extra-dimensional (ED) shift, which reflects the ability to inhibit and shift attention away from one stimulus dimension to another.

RESULTS

Participants with depression and PTSD had elevated total errors on the task with moderate effect sizes; and those with the following had deficits of small effect size: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), antisocial personality disorder, and binge-eating disorder. For ED errors, participants with PTSD, GAD, and binge-eating disorder exhibited deficits with medium effect sizes; those with the following had small effect size deficits: depression, social anxiety disorder, OCD, substance dependence, antisocial personality disorder, and gambling disorder.

CONCLUSIONS

These data indicate cognitive flexibility deficits occur across a range of mental disorders. Future work should explore whether these deficits can be ameliorated with novel treatment interventions.

Using event-related potentials to characterize inhibitory control and self-monitoring across impulsive and compulsive phenotypes: a dimensional approach to OCD

OBJECTIVE

"Subsyndromal" obsessive-compulsive disorder symptoms (OCDSs) are common and cause impaired psychosocial functioning. OCDSs are better captured by dimensional models of psychopathology, as opposed to categorical diagnoses. However, such dimensional approaches require a deep understanding of the underlying neurocognitive drivers and impulsive and compulsive traits (ie, neurocognitive phenotypes) across symptoms. This study investigated inhibitory control and self-monitoring across impulsivity, compulsivity, and their interaction in individuals (n = 40) experiencing mild-moderate OCDSs.

METHODS

EEG recording concurrent with the stop-signal task was used to elicit event-related potentials (ERPs) indexing inhibitory control (ie, N2 and P3) and self-monitoring (ie, error-related negativity and correct-related negativity (CRN): negativity following erroneous or correct responses, respectively).

RESULTS

During unsuccessful stopping, individuals high in both impulsivity and compulsivity displayed enhanced N2 amplitude, indicative of conflict between the urge to respond and need to stop (F(3, 33) = 1.48, P < .05, 95% Cl [-0.01, 0.001]). Individuals high in compulsivity and low in impulsivity showed reduced P3 amplitude, consistent with impairments in monitoring failed inhibitory control (F(3, 24) = 2.033, P < .05, 95% CI [-0.002, 0.045]). Following successful stopping, high compulsivity (independent of impulsivity) was associated with lower CRN amplitude, reflecting hypo-monitoring of correct responses (F(4, 32) = 4.76, P < .05, 95% CI [0.01, 0.02]), and with greater OCDS severity (F(3, 36) = 3.32, P < .05, 95% CI [0.03, 0.19]).

CONCLUSION

The current findings provide evidence for differential, ERP-indexed inhibitory control and self-monitoring profiles across impulsive and compulsive phenotypes in OCDSs.

Behavioral excess and disruptive conduct: A historical and taxonomic approach to the origin of the 'impulse control disorders' diagnostic construct

AIMS

Impulse control disorders (ICDs) are iatrogenic and idiopathic conditions with psychosocial and economic consequences for the affected individuals and their families (e.g. bankruptcy and divorce). However, the definition of ICDs has changed over time, and ICDs are not consistently included within existing taxonomies. We discuss the origins of the ICD diagnostic construct and its unsolved tensions.

METHODS

To contextualize the ICD diagnostic construct, we provided an overview of its origins in past centuries and followed its development across multiple editions of the Diagnostic and Statistical Manual and the International Classification of Diseases, as well as its definition within emerging ontologies.

RESULTS

Two independent roots of the ICD construct emerged: (a) the interest in behavioral excess as expressed in encyclopedic compilations (18th century) and (b) the juridical debate on disruptive conduct and responsibility (19th-20th centuries). These roots underlie the repeated taxonomic remodeling observed throughout the 20th and 21st centuries and three critical issues persisting in both clinical practice and research. First, the number of ICDs keeps increasing across the spectrum of human behaviors, disregarding common pathogenetic and phenomenological grounds. Secondly, ICDs substantially overlap with other mental conditions. Impulsivity is often neglected as a minor inconvenience or side effect when co-occurring with major diagnoses (e.g. depression) and therefore inadequately managed. Finally, ICDs' definitions display an unsolved tension between being conceived as hobby, moral fault or pathological drive, which may be responsible for stigma and delayed intervention.

CONCLUSION

The reasons that made impulse control disorders (ICDs) difficult to define from their first conceptualization are the same reasons that now complicate taxonomic efforts and diagnosis. Tracing back ICDs' roots and criticalities can help to define a common and less ambiguous theoretical framework, which may also result in the demise of the ICD construct and a move towards more clearly defined and more useful ontologies.

Binge-eating disorder in university students: high prevalence and strong link to impulsive and compulsive traits

BACKGROUND

Binge eating disorder (BED) is the most common eating disorder, and is associated with significant comorbidity, with university students being particularly vulnerable. We aimed to assess associations of BED with a wide range of comorbidities and measures of impulsivity and compulsivity in university students, to gain better understanding of its prevalence, correlates and pathophysiology.

METHODS

We carried out an internet-based survey, assessing presence of BED using a validated structured self-report diagnostic tool, demographics, substance use, impulsive behaviors, psychiatric history, and measures of impulsivity and compulsivity. Approximately 10 000 students were invited to take part. Group differences between students with current BED and students without BED were investigated.

RESULTS

A total of 3415 students completed the survey, with 83 (2.4%) screening positive for BED. BED was associated with female gender, hazardous/harmful alcohol use, depression and anxiety symptoms, low self-esteem, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, treatment for psychological/emotional problems (including prescribed medication) and trait impulsivity and compulsivity. However, the largest effect sizes were evident for associations with trait impulsivity and compulsivity.

CONCLUSIONS

The associations of BED with trait impulsivity and compulsivity implicate these latent phenotypes in its pathophysiology. The identified links between BED and a wide range of mental disorders highlight the need to screen for disordered eating in student populations, including when students present with other mental health conditions.

Meta-analysis of structural evidence for the Hierarchical Taxonomy of Psychopathology (HiTOP) model

BACKGROUND

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a classification system that seeks to organize psychopathology using quantitative evidence - yet the current model was established by narrative review. This meta-analysis provides a quantitative synthesis of literature on transdiagnostic dimensions of psychopathology to evaluate the validity of the HiTOP framework.

METHODS

Published studies estimating factor-analytic models from diagnostic and statistical manual of mental disorders (DSM) diagnoses were screened. A total of 120,596 participants from 35 studies assessing 23 DSM diagnoses were included in the meta-analytic models. Data were pooled into a meta-analytic correlation matrix using a random effects model. Exploratory factor analyses were conducted using the pooled correlation matrix. A hierarchical structure was estimated by extracting one to five factors representing levels of the HiTOP framework, then calculating congruence coefficients between factors at sequential levels.

RESULTS

Five transdiagnostic dimensions fit the DSM diagnoses well (comparative fit index = 0.92, root mean square error of approximation = 0.07, and standardized root-mean-square residual = 0.03). Most diagnoses had factor loadings >|0.30| on the expected factors, and congruence coefficients between factors indicated a hierarchical structure consistent with the HiTOP framework.

CONCLUSIONS

A model closely resembling the HiTOP framework fit the data well and placement of DSM diagnoses within transdiagnostic dimensions were largely confirmed, supporting it as valid structure for conceptualizing and organizing psychopathology. Results also suggest transdiagnostic research should (1) use traits, narrow symptoms, and dimensional measures of psychopathology instead of DSM diagnoses, (2) assess a broader array of constructs, and (3) increase focus on understudied pathologies.

Behavioral measures of impulsivity and compulsivity in adolescents with nonsuicidal self-injury

BACKGROUND

Nonsuicidal self-injury (NSSI) is prevalent among adolescents and research is needed to clarify the mechanisms which contribute to the behavior. Here, the authors relate behavioral neurocognitive measures of impulsivity and compulsivity to repetitive and sporadic NSSI in a community sample of adolescents.

METHODS

Computerized laboratory tasks (Affective Go/No-Go, Cambridge Gambling Task, and Probabilistic Reversal Task) were used to evaluate cognitive performance. Participants were adolescents aged 15 to 17 with (n = 50) and without (n = 190) NSSI history, sampled from the ROOTS project which recruited adolescents from secondary schools in Cambridgeshire, UK. NSSI was categorized as sporadic (1-3 instances per year) or repetitive (4 or more instances per year). Analyses were carried out in a series of linear and negative binomial regressions, controlling for age, gender, intelligence, and recent depressive symptoms.

RESULTS

Adolescents with lifetime NSSI, and repetitive NSSI specifically, made significantly more perseverative errors on the Probabilistic Reversal Task and exhibited significantly lower quality of decision making on the Cambridge Gambling Task compared to no-NSSI controls. Those with sporadic NSSI did not significantly differ from no-NSSI controls on task performance. NSSI was not associated with behavioral measures of impulsivity.

CONCLUSIONS

Repetitive NSSI is associated with increased behavioral compulsivity and disadvantageous decision making, but not with behavioral impulsivity. Future research should continue to investigate how neurocognitive phenotypes contribute to the onset and maintenance of NSSI, and determine whether compulsivity and addictive features of NSSI are potential targets for treatment.

Subjective assessments of research domain criteria constructs in addiction and compulsive disorders: a scoping review protocol

INTRODUCTION

Obsessive-compulsive and related disorders (OCRDs) and disorders due to addictive behaviours (DABs) are prevalent conditions that share behavioural and neurobiological characteristics. The Research Domain Criteria lists a series of constructs whose dysfunctions may be present in both groups of disorders. The present study will describe the research protocol of a scoping review of the literature on self-report scales and questionnaires that tap dysfunctional constructs that underlie OCRDs and DABs.

METHODS AND ANALYSIS

This protocol outlines a scoping review on self-report tools and questionnaires that assess OCRDs and DABs-related constructs. The scoping review will select sources in MEDLINE, EMBASE, PsychINFO and Web of Science databases. Inclusion and exclusion criteria will be designed according to the Population, Concept, Context, Types of source framework. Two reviewers will screen independently titles, abstracts and full texts to determine the eligibility of articles. A methodological framework including six stages steps ((1) identifying a research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarising and reporting the result) will be used, and the findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Information extracted will be collated, and quantitative results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate.

ETHICS AND DISSEMINATION

Ethical approval for conducting this scoping review is not required, as this study will involve secondary analysis of existing literature. The researchers will disseminate the study results via conference presentations and publication in a peer-reviewed journal.

SCOPING REVIEW PROTOCOL REGISTRATION

DOI 10.17605/OSF.IO/UJ7G5.

Characteristics of 262 adults with skin picking disorder

INTRODUCTION

Skin picking disorder (also known as excoriation disorder or dermatillomania) is a common mental health disorder currently classified as an obsessive-compulsive and related condition. Despite being first described in the 1800s, very little is known about its phenomenology and clinical presentation. Most information about this disorder to date is based on online surveys rather than in-person assessments.

METHODS

Clinical and demographic data were collected from individuals with skin-picking disorder taking part in research studies, using in-person assessments comprising validated instruments. Descriptive information was presented as to the nature of skin picking disorder.

RESULTS

The sample comprised 262 individuals, mean age 32.5 years, being 87% female. The peak age of onset of symptoms was 12.9 years, and most affected individuals (>90%) had symptom onset before age of 20 years. Typically, individuals reported picking from multiple body sites (most common was the face), and the most frequent triggers were stress and the 'feel' (i.e. texture) of the skin. Comorbidities were common, including trichotillomania, depression, generalized anxiety disorder, and impulsive/compulsive disorders (especially attention-deficit hyperactivity disorder and obsessive-compulsive disorder). The majority of people with the disorder (87.1%) had never received treatment. Of those who had received treatment in the past, 87% reported that they found the treatment helpful for their symptoms.

DISCUSSION

This study sheds new light on the clinical presentation and phenomenology of skin picking disorder. Results highlight the need for further research into its clinical presentation, longitudinal course, and treatment approaches.

Transdiagnostic phenotypes of compulsive behavior and associations with psychological, cognitive, and neurobiological affective processing

Compulsivity is a poorly understood transdiagnostic construct thought to underlie multiple disorders, including obsessive-compulsive disorder, addictions, and binge eating. Our current understanding of the causes of compulsive behavior remains primarily based on investigations into specific diagnostic categories or findings relying on one or two laboratory measures to explain complex phenotypic variance. This proof-of-concept study drew on a heterogeneous sample of community-based individuals (N = 45; 18-45 years; 25 female) exhibiting compulsive behavioral patterns in alcohol use, eating, cleaning, checking, or symmetry. Data-driven statistical modeling of multidimensional markers was utilized to identify homogeneous subtypes that were independent of traditional clinical phenomenology. Markers were based on well-defined measures of affective processing and included psychological assessment of compulsivity, behavioral avoidance, and stress, neurocognitive assessment of reward vs. punishment learning, and biological assessment of the cortisol awakening response. The neurobiological validity of the subtypes was assessed using functional magnetic resonance imaging. Statistical modeling identified three stable, distinct subtypes of compulsivity and affective processing, which we labeled "Compulsive Non-Avoidant", "Compulsive Reactive" and "Compulsive Stressed". They differed meaningfully on validation measures of mood, intolerance of uncertainty, and urgency. Most importantly, subtypes captured neurobiological variance on amygdala-based resting-state functional connectivity, suggesting they were valid representations of underlying neurobiology and highlighting the relevance of emotion-related brain networks in compulsive behavior. Although independent larger samples are needed to confirm the stability of subtypes, these data offer an integrated understanding of how different systems may interact in compulsive behavior and provide new considerations for guiding tailored intervention decisions.

Distress-driven impulsivity interacts with trait compulsivity in association with problematic drinking: A two-sample study

OBJECTIVE

Problematic drinking is highly prevalent among the general population, oftentimes leading to significant negative consequences, including physical injury, psychological problems and financial hardship. In order to design targeted early interventions for problematic drinking, it is important to understand the mechanisms that render individuals at risk for and/or maintain this behavior. Two candidate drivers of problematic drinking are distress-driven impulsivity and trait compulsivity, with recent research suggesting these constructs may interact to enhance risk for addictive behaviors. The current study examined whether individual differences in distress-driven impulsivity and trait compulsivity interact in relation to problematic drinking.

METHOD

Distress-driven impulsivity (indexed by the S-UPPS-P negative urgency subscale), trait compulsivity (indexed by the CHIT scale) and problematic drinking (indexed by the BATCAP alcohol scale) were assessed in two independent online samples (Sample 1, n = 117; Sample 2, n = 474). Bootstrapped moderation analysis was conducted to examine whether trait compulsivity moderated the relationship between distress-driven impulsivity and problematic drinking.

RESULTS

In both samples, there was a significant interaction between distress-driven impulsivity and trait compulsivity in relation to problematic drinking. Follow-up tests revealed that, in both samples, higher distress-driven impulsivity was associated with more problematic drinking behaviors among participants with high trait compulsivity only.

CONCLUSIONS

The current findings add to the growing literature supporting an interactive relationship between impulsivity and compulsivity-related traits in relation to addictive behaviors and have implications for informing early detection of risk and targeted early interventions.

Impulsivity and compulsivity as parallel mediators of emotion dysregulation in eating-related addictive-like behaviors, alcohol use, and compulsive exercise

INTRODUCTION

Transdiagnostically relevant psychological traits associated with psychiatric disorders are increasingly being researched, notably in substance use and addictive behaviors. We investigated whether emotion dysregulation mediated by impulsivity and/or compulsivity could explain variance in binge eating, food addiction, self-starvation, and compulsive exercise, as well as alcohol use (addictive-like behaviors relevant to the obesity and eating disorder fields).

METHOD

A general population sample of adults (N = 500, mean age = 32.5 years), females (n = 376) and males (n = 124), completed the Difficulties in Emotion Regulation Scale-16, the Trait Rash Impulsivity Scale, the Obsessive-Compulsive Inventory-Revised, the Eating Disorders Examination Questionnaire, the Self-Starvation Scale, the Exercise Dependence Scale, the Yale Food Addiction Scale, and the Alcohol Use Disorders Identification Test online. Besides gender comparisons and intercorrelations between measures, we used predefined multiple mediation models with emotion dysregulation as independent variable, impulsivity and compulsivity as parallel mediators, to investigate whether these factors contributed explanatory power to each addictive-like behavior as outcome, also using age and body mass index as covariates.

RESULTS

Females scored higher than males on emotion dysregulation and the eating-related addictive-like behaviors food addiction, self-starvation, and binge eating. Intercorrelations between measures showed that emotion dysregulation and compulsivity were associated with all outcome variables, impulsivity with all except compulsive exercise, and the eating-related behaviors intercorrelated strongly. Mediation models showed full or partial mediation of emotion dysregulation for all behaviors, especially via compulsivity, suggesting a behavior-specific pattern. Mediation models were not affected by age or gender.

DISCUSSION

Addictive-like behaviors seemed to be maintained by trait levels of emotion dysregulation, albeit channeled via trait levels of compulsivity and/or impulsivity. The role of emotion dysregulation may help us to understand why addictive-like behaviors can be difficult to change in both clinical and nonclinical groups, and may be informative for treatment-planning in patients where these behaviors are present. Our findings support adopting a more dimensional approach to psychiatric classification by focusing psychological facets such as those studied.

The role of psychological distress in the relationship between lifestyle and compulsivity: An analysis of independent, bi-national samples

BACKGROUND

Poor mental health is a state of psychological distress that is influenced by lifestyle factors such as sleep, diet, and physical activity. Compulsivity is a transdiagnostic phenotype cutting across a range of mental illnesses including obsessive-compulsive disorder, substance-related and addictive disorders, and is also influenced by lifestyle. Yet, how lifestyle relates to compulsivity is presently unknown, but important to understand to gain insights into individual differences in mental health. We assessed (a) the relationships between compulsivity and diet quality, sleep quality, and physical activity, and (b) whether psychological distress statistically contributes to these relationships.

METHODS

We collected harmonized data on compulsivity, psychological distress, and lifestyle from two independent samples (Australian n = 880 and US n = 829). We used mediation analyses to investigate bidirectional relationships between compulsivity and lifestyle factors, and the role of psychological distress.

RESULTS

Higher compulsivity was significantly related to poorer diet and sleep. Psychological distress statistically mediated the relationship between poorer sleep quality and higher compulsivity, and partially statistically mediated the relationship between poorer diet and higher compulsivity.

CONCLUSIONS

Lifestyle interventions in compulsivity may target psychological distress in the first instance, followed by sleep and diet quality. As psychological distress links aspects of lifestyle and compulsivity, focusing on mitigating and managing distress may offer a useful therapeutic approach to improve physical and mental health. Future research may focus on the specific sleep and diet patterns which may alter compulsivity over time to inform lifestyle targets for prevention and treatment of functionally impairing compulsive behaviors.

Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?

BACKGROUND

There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia.

METHODS

This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists.

RESULTS

Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia.

CONCLUSION

Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.

Risking Everything in Obsessive-Compulsive Disorder: An Analogue Decision-Making Study

An experiment examined decision-making processes among nonclinical participants with low or high levels of OCD symptomatology (N = 303). To better simulate the decision environments that are most likely to be problematic for clients with OCD, we employed decision tasks that incorporated "black swan" options that have a very low probability but involve substantial loss. When faced with a choice between a safer option that involved no risk of loss or a riskier alternative with a very low probability of substantial loss, most participants chose the safer option regardless of OCD symptom level. However, when faced with choices between options that had similar expected values to the previous choices, but where each option had some low risk of a substantial loss, there was a significant shift towards riskier decisions. These effects were stronger when the task involved a contamination based, health-relevant decision task as compared to one with financial outcomes. The results suggest that both low and high symptom OC participants approach decisions involving risk-free options and decisions involving risky alternatives in qualitatively different ways. There was some evidence that measures of impulsivity were better predictors of the shift to risky decision making than OCD symptomatology.

Writing Abilities in Compulsive Prisoners

Research has found links between academic failure and criminal offending and suggest that many incarcerated young people have experienced significant behavioral and learning problems in school, which could result in criminal outcomes and poor academic performance. The objective of this study was to analyse writing disorders in impulsive and compulsive prisoners. The sample was composed of 194 male prisoners, of which 81 had been diagnosed with Antisocial Personality Disorder and 113 with Obsessive Compulsive Personality Disorder. Male participants were recruited at the Granada Prison Center. They completed the Demographic, Crime, and Institutional Behavior Interview; the International Personality Disorder Examination (IPDE); The Symptom Checklist (SCL-90-R) and Assessment Battery of Writing Processes (PROESC in its Spanish acronym). We found that prisoners with writing disorders generally have difficulties in the skills necessary to write properly due to impulsive and compulsive behavior.

Impulsivity and Compulsivity and Their Relationship with Non-Adherence to Treatment in the Prison Population

The main challenge of interventions in penitentiary institutions is the re-education and reintegration of inmates, i.e., that inmates have the intention and ability to live law-abiding lives. Therefore, an increase in self-control or, on the contrary, the decrease or elimination of impulsive versus compulsive behaviors becomes necessary. This study aimed to evaluate the role of impulsivity versus compulsivity in treatment adherence in the prison population. The study included 134 men from the Penitentiary Center of Granada who were divided into two groups. Group 1 was considered treatment adherent, and Group 2 was considered non-adherent to treatment. The following instruments were used: Symptom Inventory (SCL-90-R), Addiction Severity Index (EuropASI), Impulsivity Scale (UPPS-P), and Compulsive Belief Questionnaire (OBQ-44). Statistically significant differences were found in impulsivity in the dimensions of negative urgency, sensation seeking, and positive urgency, with higher scores in all cases for the non-adherent group than for the adherent group. We also found statistically significant differences in responsibility/inhibition, perfectionism/uncertainty, and importance/control, with higher scores for the non-adherent group compared to the adherent group. Treatment adherence is inversely related to impulsive and compulsive behaviors.

Loss of control over eating: A systematic review of task based research into impulsive and compulsive processes in binge eating

Recurring episodes of excessive food intake in binge eating disorder can be understood through the lens of behavioral control systems: patients repeat maladaptive behaviors against their explicit intent. Self-report measures show enhanced impulsivity and compulsivity in binge eating (BE) but are agnostic as to the processes that might lead to impulsive and compulsive behavior in the moment. Task-based neurocognitive investigations can tap into those processes. In this systematic review, we synthesize neurocognitive research on behavioral impulsivity and compulsivity in BE in humans and animals, published between 2010-2020. Findings on impulsivity are heterogeneous. Findings on compulsivity are sparse but comparatively consistent, indicating an imbalance of goal-directed and habitual control as well as deficits in reversal learning. We urge researchers to address heterogeneity related to mood states and the temporal dynamics of symptoms, to systematically differentiate contributions of body weight and BE, and to ascertain the validity and reliability of tasks. Moreover, we propose to further scrutinize the compulsivity findings to unravel the computational mechanisms of a potential reinforcement learning deficit.

Associations between dimensions of behaviour, personality traits, and mental-health during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic (including lockdown) is likely to have had profound but diverse implications for mental health and well-being, yet little is known about individual experiences of the pandemic (positive and negative) and how this relates to mental health and well-being, as well as other important contextual variables. Here, we analyse data sampled in a large-scale manner from 379,875 people in the United Kingdom (UK) during 2020 to identify population variables associated with mood and mental health during the COVID-19 pandemic, and to investigate self-perceived pandemic impact in relation to those variables. We report that while there are relatively small population-level differences in mood assessment scores pre- to peak-UK lockdown, the size of the differences is larger for people from specific groups, e.g. older adults and people with lower incomes. Multiple dimensions underlie peoples’ perceptions, both positive and negative, of the pandemic’s impact on daily life. These dimensions explain variance in mental health and can be statistically predicted from age, demographics, home and work circumstances, pre-existing conditions, maladaptive technology use and personality traits (e.g., compulsivity). We conclude that a holistic view, incorporating the broad range of relevant population factors, can better characterise people whose mental health is most at risk during the COVID-19 pandemic.

The COVID-19 pandemic has affected people’s health and well-being. Here, the authors characterize self-reported impact of the pandemic (positive and negative) at a large scale in the United Kingdom, and show variance among individual circumstances.

Neurochemical substrates linked to impulsive and compulsive phenotypes in addiction: A preclinical perspective

Drug compulsion manifests in some but not all individuals and implicates multifaceted processes including failures in top-down cognitive control as drivers for the hazardous pursuit of drug use in some individuals. As a closely related construct, impulsivity encompasses rash or risky behaviour without foresight and underlies most forms of drug taking behaviour, including drug use during adverse emotional states (i.e., negative urgency). While impulsive behavioural dimensions emerge from drug-induced brain plasticity, burgeoning evidence suggests that impulsivity also predates the emergence of compulsive drug use. Although the neural substrates underlying the apparently causal relationship between trait impulsivity and drug compulsion are poorly understood, significant advances have come from the interrogation of defined limbic cortico-striatal circuits involved in motivated behaviour and response inhibition, together with chemical neuromodulatory influences from the ascending neurotransmitter systems. We review what is presently known about the neurochemical mediation of impulsivity, in its various forms, and ask whether commonalities exist in the neurochemistry of compulsive drug-motivated behaviours that might explain individual risk for addiction.

The place of obsessive-compulsive and related disorders in the compulsive-impulsive spectrum: a cluster-analytic study

BACKGROUND

The extent to which obsessive-compulsive and related disorders (OCRDs) are impulsive, compulsive, or both requires further investigation. We investigated the existence of different clusters in an online nonclinical sample and in which groups DSM-5 OCRDs and other related psychopathological symptoms are best placed.

METHODS

Seven hundred and seventy-four adult participants completed online questionnaires including the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), the Barratt Impulsiveness Scale (BIS-15), and a series of DSM-5 OCRDs symptom severity and other psychopathological measures. We used K-means cluster analysis using CHI-T and BIS responses to test three and four factor solutions. Next, we investigated whether different OCRDs symptoms predicted cluster membership using a multinomial regression model.

RESULTS

The best solution identified one "healthy" and three "clinical" clusters (ie, one predominantly "compulsive" group, one predominantly "impulsive" group, and one "mixed"-"compulsive and impulsive group"). A multinomial regression model found obsessive-compulsive, body dysmorphic, and schizotypal symptoms to be associated with the "mixed" and the "compulsive" clusters, and hoarding and emotional symptoms to be related, on a trend level, to the "impulsive" cluster. Additional analysis showed cognitive-perceptual schizotypal symptoms to be associated with the "mixed" but not the "compulsive" group.

CONCLUSIONS

Our findings suggest that obsessive-compulsive disorder; body dysmorphic disorder and schizotypal symptoms can be mapped across the "compulsive" and "mixed" clusters of the compulsive-impulsive spectrum. Although there was a trend toward hoarding being associated with the "impulsive" group, trichotillomania, and skin picking disorder symptoms did not clearly fit to the demarcated clusters.

The Influence of Trait Compulsivity and Impulsivity on Addictive and Compulsive Behaviors During COVID-19

Background: The COVID-19 pandemic has resulted in high levels of psychological distress worldwide, with experts expressing concern that this could result in corresponding increases in addictive behaviors as individuals seek to cope with their distress. Further, some individuals may be at greater risk than others for developing problematic addictive behaviors during times of high stress, such as individuals with high trait impulsivity and compulsivity. Despite the potential of such knowledge to inform early detection of risk, no study to date has examined the influence of trait impulsivity and compulsivity on addictive behaviors during COVID-19. Toward this aim, the current study examined the association between impulsive and compulsive traits and problematic addictive and compulsive behaviors during the first COVID-19 lockdown in Australia. Methods: Eight hundred seventy-eight adults completed a cross-sectional online survey during the first lockdown, between late May to June 2020. Participants completed scales for addictive and compulsive behaviors for the period prior to and during lockdown for problematic eating, pornography, internet use, gambling, drinking, and obsessive-compulsive behaviors. Negative binomial regressions examined the associations between impulsivity, compulsivity, and their interaction with problematic behaviors during lockdown, controlling for age, gender, sample, psychological distress, exposure to COVID-related stressors, and pre-COVID problems. Results: Greater trait compulsivity was associated with more problematic obsessive-compulsive behaviors (p < 0.001) and less problematic drinking (p = 0.038) during lockdown. Further, trait compulsivity interacted with trait impulsivity in relation to problematic eating behaviors (p = 0.014) such that greater trait compulsivity was associated with more problems among individuals with low impulsivity only (p = 0.030). Finally, psychological distress and/or exposure to COVID-related stressors were associated with greater problems across all addictive and compulsive behaviors, as was severity of pre-COVID problems. Discussion: Trait compulsivity was associated with addictive and compulsive behaviors in different ways. Further, the finding that stress-related variables (psychological distress and COVID-related stressors) were associated with greater problems across all lockdown behaviors supports the idea that stress may facilitate, or otherwise be associated with, problematic behaviors. These findings highlight the need for interventions that enhance resilience to stress, which in turn may reduce risk for addictive and compulsive disorders.

ICD-11 Personality Disorders: Utility and Implications of the New Model

The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as "mild," "moderate," or "severe." Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.

Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools

INTRODUCTION

Impulsivity and compulsivity are important constructs, relevant to understanding behaviour in the general population, as well as in particular mental disorders (e.g. attention deficit hyperactivity disorder, obsessive-compulsive disorder). The current paper provides a narrative review of self-report impulsivity and compulsivity scales.

METHODS

A literature search was conducted using the following terms: ("impulsivity" OR "compulsivity") AND ("self-report" OR "questionnaire" OR "psychometric" OR "scale").

RESULTS

25 impulsive and 11 compulsive scales were identified, which varied considerably in psychometric properties, convenience, and validity. For impulsivity, the most commonly used scales were the BIS and the UPPS-P, whilst for compulsivity, the Padua Inventory was commonly used. The majority of compulsivity scales measured OCD symptoms (obsessions and compulsions) rather than being trans-diagnostic or specific to compulsivity (as opposed to obsessions). Scales capable of overcoming these limitations were highlighted.

DISCUSSION

This review provides clarity regarding relative advantages and disadvantages of different scales relevant to the measurement of impulsivity and compulsivity in many contexts. Areas for further research and refinement are highlighted.

Eating disorders with over-exercise: A cross-sectional analysis of the mediational role of problematic usage of the internet in young people

Eating disorders are widespread illnesses with significant global impact. There is growing concern about how young people overuse online resources leading to mental health sequelae. We gathered data from 639 individuals from a population cohort. Participants were all young adults at the point of contact and were grouped as having probable eating disorder with excessive exercise (n = 37) or controls (n = 602). We measured obsessionality, compulsivity, impulsivity, and problematic internet use. Group differences in these domains were evaluated; and structural equation modelling (SEM) was used to assess structural relationships between variables. Cases had higher scores of obsessional thoughts of threat (Cohen's d = 0.94, p < 0.001), intolerance towards uncertainty (Cohen's d = 0.72; p < 0.001), thoughts of importance and control (Cohen's d = 0.65, p < 0.01), compulsivity (Cohen's d = 0.72; p < 0.001), negative urgency (Cohen's d = 0.75, p < 0.001), and higher problematic usage of the internet (Cohen's d = 0.73; p-corrected <0.001). Our SEM showed significant partial mediation of problematic internet use on both the effect of obsessionality latent factor on cases (z-value = 2.52, p < 0.05), as well as of sensation seeking latent factor on cases (z-value = 2.09, p < 0.05). Youth with eating disorder and heightened exercise levels have increased obsessive thoughts of threat, compulsivity traits and sensation seeking impulsivity. The association between obsessive thoughts and eating disorders, as well as sensation seeking and eating disorders were partially mediated by problematic internet use. Problematic internet use may be playing a role in the development or maintenance of eating disorder symptoms in the background of obsessional thoughts and sensation seeking impulsive traits.

Reward-Related Attentional Capture Moderates the Association between Fear-Driven Motives and Heavy Drinking

BACKGROUND

To date, there has been little investigation on how motivational and cognitive mechanisms interact to influence problematic drinking behaviours. Towards this aim, the current study examined whether reward-related attentional capture is associated with reward, fear (relief), and habit drinking motives, and further, whether it interacts with these motives in relation to problematic drinking patterns.

METHODS

Ninety participants (mean age = 34.8 years, SD = 9.1, 54% male) who reported having consumed alcohol in the past month completed an online visual search task that measured reward-related attentional capture as well as the Habit Reward Fear Scale, a measure of drinking motives. Participants also completed measures of psychological distress, impulsivity, compulsive drinking, and consumption items of Alcohol Use Disorders Identification Test. Regression analyses examined the associations between motives for alcohol consumption and reward-related attentional capture, as well as the associations between reward-related attentional capture, motives, and their interaction, with alcohol consumption and problems.

RESULTS

Greater reward-related attentional capture was associated with greater reward motives. Further, reward-related attentional capture also interacted with fear motives in relation to alcohol consumption. Follow-up analyses showed that this interaction was driven by greater fear motives being associated with heavier drinking among those with lower reward-related attentional capture (i.e., "goal-trackers").

CONCLUSION

These findings have implications for understanding how cognition may interact with motives in association with problematic drinking. Specifically, the findings highlight different potential pathways to problematic drinking according to an individual's cognitive-motivational profile and may inform tailored interventions to target profile-specific mechanisms. Finally, these findings offer support for contemporary models of addiction that view excessive goal-directed behaviour under negative affect as a critical contributor to addictive behaviours.

Reward history impacts attentional orienting and inhibitory control on untrained tasks

It has been robustly shown that stimuli with reward history receive attentional priority. However, the majority of this research tests reward history effects on attentional bias using similar tasks for both the reward learning phase and the unrewarded testing phase, which limits our understanding of how the effects of reward history generalize beyond the trained tasks and mental sets. Across two new experiments, the current study addresses these issues by first associating reward with a stimulus in a visual search paradigm, and then testing value-driven effects of that stimulus in untrained and unrewarded tasks, including a cueing paradigm, a go/no-go task, and a delay discounting task. Results of Experiment 1 demonstrate that history of reward association in a visual search task generalizes to value-driven attentional bias in a different attention paradigm (i.e., cueing), indicating these effects are indeed attributable to imbued value that can transfer to other tasks beyond that in which the reward was trained. The results of Experiment 2 demonstrate that in addition to eliciting attentional orienting on untrained tasks, reward history can lead to better inhibitory control in the go/no-go task. We find no evidence for reward history effects in the delay discounting task. Together, these experiments demonstrate that when the reward association task is in the attention domain, reward history modulates attentional priority, and this effect generalizes to untrained and unrewarded tasks that utilize both spatial and nonspatial attention.

Heritability of overlapping impulsivity and compulsivity dimensional phenotypes

Impulsivity and compulsivity are traits relevant to a range of mental health problems and have traditionally been conceptualised as distinct constructs. Here, we reconceptualised impulsivity and compulsivity as partially overlapping phenotypes using a bifactor modelling approach and estimated heritability for their shared and unique phenotypic variance within a classical twin design. Adult twin pairs (N = 173) completed self-report questionnaires measuring psychological processes related to impulsivity and compulsivity. We fitted variance components models to three uncorrelated phenotypic dimensions: a general impulsive-compulsive dimension; and two narrower phenotypes related to impulsivity and obsessiveness.There was evidence of moderate heritability for impulsivity (A² = 0.33), modest additive genetic or common environmental effects for obsessiveness (A² = 0.25; C² = 0.23), and moderate effects of common environment (C² = 0.36) for the general dimension, This general impulsive-compulsive phenotype may reflect a quantitative liability to related mental health disorders that indexes exposure to potentially modifiable environmental risk factors.

The role of Experiential Avoidance in transdiagnostic compulsive behavior: A structural model analysis

Compulsivity is recognized as a transdiagnostic phenotype, underlying a variety of addictive and obsessive-compulsive behaviors. However, current understanding of how it should be operationalized and the processes contributing to its development and maintenance is limited. The present study investigated if there was a relationship between the affective process Experiential Avoidance (EA), an unwillingness to tolerate negative internal experiences, and the frequency and severity of transdiagnostic compulsive behaviors. A large sample of adults (N = 469) completed online questionnaires measuring EA, psychological distress and the severity of seven obsessive-compulsive and addiction-related behaviors. Using structural equation modelling, results indicated a one-factor model of compulsivity was superior to the two-factor model (addictive- vs OCD-related behaviors). The effect of EA on compulsivity was fully mediated by psychological distress, which in turn had a strong direct effect on compulsivity. This suggests distress is a key mechanism in explaining why people with high EA are more prone to compulsive behaviors. The final model explained 41% of the variance in compulsivity, underscoring the importance of these constructs as likely risk and maintenance factors for compulsive behavior. Implications for designing effective psychological interventions for compulsivity are discussed.

Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study

BACKGROUND

Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission.

METHODS

We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission.

RESULTS

A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission.

CONCLUSION

A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.

Compulsivity is measurable across distinct psychiatric symptom domains and is associated with familial risk and reward-related attentional capture

BACKGROUND

Compulsivity can be seen across various mental health conditions and refers to a tendency toward repetitive habitual acts that are persistent and functionally impairing. Compulsivity involves dysfunctional reward-related circuitry and is thought to be significantly heritable. Despite this, its measurement from a transdiagnostic perspective has received only scant research attention. Here we examine both the psychometric properties of a recently developed compulsivity scale, as well as its relationship with compulsive symptoms, familial risk, and reward-related attentional capture.

METHODS

Two-hundred and sixty individuals participated in the study (mean age = 36.0 [SD = 10.8] years; 60.0% male) and completed the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), along with measures of psychiatric symptoms and family history thereof. Participants also completed a task designed to measure reward-related attentional capture (n = 177).

RESULTS

CHI-T total scores had a normal distribution and acceptable Cronbach's alpha (0.84). CHI-T total scores correlated significantly and positively (all p < 0.05, Bonferroni corrected) with Problematic Usage of the Internet, disordered gambling, obsessive-compulsive symptoms, alcohol misuse, and disordered eating. The scale was correlated significantly with history of addiction and obsessive-compulsive related disorders in first-degree relatives of participants and greater reward-related attentional capture.

CONCLUSIONS

These findings suggest that the CHI-T is suitable for use in online studies and constitutes a transdiagnostic marker for a range of compulsive symptoms, their familial loading, and related cognitive markers. Future work should more extensively investigate the scale in normative and clinical cohorts, and the role of value-modulated attentional capture across compulsive disorders.

The 21-item Barratt Impulsiveness Scale Revised (BIS-R-21): An alternative three-factor model

BACKGROUND AND AIMS

Due to its important role in both healthy groups and those with physical, mental and behavioral disorders, impulsivity is a widely researched construct. Among various self-report questionnaires of impulsivity, the Barratt Impulsiveness Scale is arguably the most frequently used measure. Despite its international use, inconsistencies in the suggested factor structure of its latest version, the BIS-11, have been observed repeatedly in different samples. The goal of the present study was therefore to test the factor structure of the BIS-11 in several samples.

METHODS

Exploratory and confirmatory factor analyses were conducted on two representative samples of Hungarian adults (N = 2,457; N = 2,040) and a college sample (N = 765).

RESULTS

Analyses did not confirm the original model of the measure in any of the samples. Based on explorative factor analyses, an alternative three-factor model (cognitive impulsivity; behavioral impulsivity; and impatience/restlessness) of the Barratt Impulsiveness Scale is suggested. The pattern of the associations between the three factors and aggression, exercise, smoking, alcohol use, and psychological distress supports the construct validity of this new model.

DISCUSSION

The new measurement model of impulsivity was confirmed in two independent samples. However, it requires further cross-cultural validation to clarify the content of self-reported impulsivity in both clinical and nonclinical samples.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder

BACKGROUND AND AIMS

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

METHODS

Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

RESULTS

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

CONCLUSION

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Reward-related attentional capture and cognitive inflexibility interact to determine greater severity of compulsivity-related problems

BACKGROUND AND OBJECTIVES

Neurocognitive processes are key drivers of addictive and compulsive disorders. The current study examined whether reward-related attentional capture and cognitive inflexibility are associated with impulsive and/or compulsive personality traits, and whether these cognitive characteristics interact to predict greater compulsivity-related problems across obsessive-compulsive and drinking behaviors.

METHODS

One-hundred and seventy-three participants (mean age = 34.5 years, S.D = 8.4, 42% female) completed an online visual search task to measure reward-related attentional capture and its persistence following reversal of stimulus-reward contingencies. Participants also completed questionnaires to assess trait impulsivity, compulsivity, alcohol use, and obsessive-compulsive behaviors.

RESULTS

Greater reward-related attentional capture was associated with trait compulsivity, over and above all impulsivity dimensions, while greater cognitive inflexibility was associated with higher negative urgency (distress-elicited impulsivity). Reward-related attentional capture and cognitive inflexibility interacted to predict greater compulsivity-related problems among participants who reported obsessive-compulsive behaviors in the past month (n = 57) as well as current drinkers (n = 88). Follow-up analyses showed that, for OCD behaviors, this interaction was driven by an association between higher reward-related attentional capture and more problematic behaviors among cognitively inflexible participants only. For drinking, the same pattern was seen, albeit at trend level.

LIMITATIONS

This study includes a non-clinical, online sample and is cross-sectional, thus its findings need to be interpreted with these limitations in mind.

CONCLUSIONS

Reward-related attentional capture and cognitive flexibility are related to trait compulsivity and impulsivity (negative urgency) respectively, and interact to determine more problematic behaviors.

Self-reported and neurocognitive impulsivity in obsessive-compulsive disorder

BACKGROUND

Although a behavioural addiction model of obsessive-compulsive disorder (OCD) has been proposed, it is still unclear if and how self-report and neurocognitive measures of impulsivity (such as risk-taking-, reflection- and motor-impulsivities) are impaired and/or inter-related in this particular clinical population.

METHODS

Seventeen OCD patients and 17 age-, gender-, education- and IQ-matched controls completed the Barratt Impulsivity Scale, the Obsessive-Compulsive Inventory-Revised, and the Beck Depression Inventory and were evaluated with the Yale-Brown Obsessive-Compulsive Scale and three computerized paradigms including reward (the Cambridge Gambling Task), reflection (the Information Sampling Task) and motor impulsivity (Stop Signal Task).

RESULTS

Despite not differing from healthy controls in any neurocognitive impulsivity domain, OCD patients demonstrated increased impulsivity in a self-report measure (particularly attentional impulsivity). Further, attentional impulsivity was predicted by severity of obsessive-compulsive symptoms.

CONCLUSIONS

Our findings suggest that OCD is characterized by a subjective (rather than objective) impulsivity; in addition, self-reported impulsivity was largely determined by severity of OCD symptoms.

Inhibition-Related Cortical Hypoconnectivity as a Candidate Vulnerability Marker for Obsessive-Compulsive Disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) is a prevalent neuropsychiatric condition, with biological models implicating disruption of cortically mediated inhibitory control pathways, ordinarily serving to regulate our environmental responses and habits. The aim of this study was to evaluate inhibition-related cortical dysconnectivity as a novel candidate vulnerability marker of OCD.

METHODS

In total, 20 patients with OCD, 18 clinically asymptomatic first-degree relatives of patients with OCD, and 20 control participants took part in a neuroimaging study comprising a functional magnetic resonance imaging stop signal task. Brain activations during the contrasts of interest were cluster thresholded, and a three-dimensional watershed algorithm was used to decompose activation maps into discrete clusters. Functional connections between these key neural nodes were examined using a generalized psychophysiological interaction model.

RESULTS

The three groups did not differ in terms of age, education level, gender, IQ, or behavioral task parameters. Patients with OCD exhibited hyperactivation of the bilateral occipital cortex during the task versus the other groups. Compared with control participants, patients with OCD and their relatives exhibited significantly reduced connectivity between neural nodes, including frontal cortical, middle occipital cortical, and cerebellar regions, during the stop signal task.

CONCLUSIONS

These findings indicate that hypoconnectivity between anterior and posterior cortical regions during inhibitory control represents a candidate vulnerability marker for OCD. Such vulnerability markers, if found to generalize, may be valuable to shed light on etiological processes contributing not only to OCD but also obsessive-compulsive-related disorders more widely.

Trait impulsiveness and response inhibition in young adults: Moderating role of resting respiratory sinus arrhythmia

Trait impulsiveness is a multifaceted construct that includes motor-, attention/cognitive- and non-planning facets, but how specific impulsiveness facets are associated with the deficit of response inhibition is not well understood. Resting respiratory sinus arrhythmia (RSA), which is considered as an index of cardiac vagal tone has been demonstrated to play a moderating role in the associations between many individual's variables. Whether resting RSA moderates the relationships between the facets of trait impulsiveness and response inhibition remains unknown. To examine these issues, data of self-reported trait impulsiveness, as assessed using the Barratt Impulsiveness Scale (BIS-II), 5-min resting RSA, and response accuracy (ACC) on a modified Go/NoGo task were collected from 132 college students. Results indicated that ACC of NoGo condition on the Go/NoGo task was negatively correlated with BIS motor and BIS total. Trait motor impulsiveness negatively predicted ACC of NoGo condition on the Go/NoGo task in the low resting RSA group but not in the high resting RSA group. This finding suggests that cardiac vagal tone could moderate the association between trait impulsiveness, especially motor impulsiveness, and deficits of response inhibition.

International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1

INTRODUCTION

The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism.

OBJECTIVE

The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets.

METHODS

We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated.

RESULTS

Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types.

CONCLUSIONS

The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).